The impact of heat waves and cold spells on respiratory emergency department visits in Beijing, China.

The objectives of this article were (i) to find the association between extreme temperatures and respiratory emergency department (ED) visits and (ii) to explore the added effects of heat waves and cold spells on respiratory ED visits in Beijing from 2009 to 2012. A quasi-Poisson generalised linear model combined with a distributed lag non-linear model was performed to quantify this association. The results indicated that (i) ambient temperature related to respiratory ED visits exhibited a U-shaped association. The minimum-morbidity temperature was 21.5°C. (ii) the peak relative risk (RR) of cold spells on respiratory ED visits was observed in relatively mild cold spells with a threshold below the 3rd percentile for 4days (RR=1.885, 95% CI: 1.300-2.734), and there was a reduction in risk during extremely chilly cold spells (RR=1.811, 95% CI: 1.229-2.667). However, the risk of heat waves increased with the thresholds, and the greatest risk was found for extremely hot heat waves (RR=1.932, 95% CI: 1.461-2.554). (iii) the added effect of heat waves was small, and we observed that the added heat wave effect only introduced additional risk in females (RR=1.166, 95% CI: 1.007-1.349). No added effect of cold spells was identified. In conclusion, the main effects of heat waves and cold spells on respiratory ED visits showed different change trends. In addition, the added effects of extreme temperatures on respiratory ED visits were small and negligible.

Impact of ambient temperature on morbidity and mortality: An overview of reviews.

The objectives were (i) to conduct an overview of systematic reviews to summarize evidence from and evaluate the methodological quality of systematic reviews assessing the impact of ambient temperature on morbidity and mortality; and (ii) to reanalyse meta-analyses of cold-induced cardiovascular morbidity in different age groups. The registration number is PROSPERO-CRD42016047179. PubMed, Embase, the Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health were systematically searched to identify systematic reviews. Two reviewers independently selected studies for inclusion, extracted data, and assessed quality. The Assessment of Multiple Systematic Reviews (AMSTAR) checklist was used to assess the methodological quality of included systematic reviews. Estimates of morbidity and mortality risk in association with heat exposure, cold exposure, heatwaves, cold spells and diurnal temperature ranges (DTRs) were the primary outcomes. Twenty-eight systematic reviews were included in the overview of systematic reviews. (i) The median (interquartile range) AMSTAR scores were 7 (1.75) for quantitative reviews and 3.5 (1.75) for qualitative reviews. (ii) Heat exposure was identified to be associated with increased risk of cardiovascular, cerebrovascular and respiratory mortality, but was not found to have an impact on cardiovascular or cerebrovascular morbidity. (iii) Reanalysis of the meta-analyses indicated that cold-induced cardiovascular morbidity increased in youth and middle-age (RR=1.009, 95% CI: 1.004-1.015) as well as the elderly (RR=1.013, 95% CI: 1.007-1.018). (iv) The definitions of temperature exposure adopted by different studies included various temperature indicators and thresholds. In conclusion, heat exposure seemed to have an adverse effect on mortality and cold-induced cardiovascular morbidity increased in the elderly. Developing definitions of temperature exposure at the regional level may contribute to more accurate evaluations of the health effects of temperature.

[A case-crossover analysis of heat wave and hospital emergency department visits for cardiovascular diseases in 3 hospitals in Beijing].

OBJECTIVE: To explore the acute health effect of heat wave on cardiovascular emergency department visits ( EDVs ) in Beijing. METHODS: The bidirectional symmetric cases-crossover design was used to analyze the association between heat wave and EDVs for cardiovascular diseases in three hospitals of Beijing from 2009 to 2011. RESULTS: During the study period, the heat wave occurred five times, including 33 days with high temperature above 35 degrees C and 23 days heat wave. In the bidirectional symmetric cases-crossover design with 1 : 6 matched pairs, the heat wave at the current day has the highest effect on cardiovascular EDVs. The OR values in EDVs for cardiovascular diseases was 1.834 (95% CI 1.767 - 1.922) along with 1 degrees C increase in the maximum temperature. For the hypertension, ischemia heart disease and cerebrovascular disease, the corresponding OR values were 1.912 (95% CI 1.758 - 2.080), 1.770 (95% CI 1.627 - 1.926) and 1.846 (95% CI 1.725 - 1.976), respectively. The people aged 65 years and older were associated slightly stronger with heat wave than the people under the age of 65 years statistically. After being adjusted the other meteorological factors and air pollutants, the significant associations were also found between the heat wave and cardiovascular EDVs, and all adjusted ORs were positively increased. CONCLUSION: The acute health effect of heat wave is significantly associated with EDVs for cardiovascular diseases in Beijing.

Gender, Age and Season as Modifiers of the Effects of Diurnal Temperature Range on Emergency Room Admissions for Cause-Specific Cardiovascular Disease among the Elderly in Beijing.

BACKGROUND: Diurnal temperature range (DTR) is an important index of climate change and variability. It is also a risk factor affecting human health. However, limited evidence is available to illustrate the effect of DTR modification on cause-specific cardiovascular disease among the elderly. METHODS: A semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between DTR and daily emergency room (ER) admissions for cause-specific cardiovascular diseases among the elderly from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by gender and age, and examined the effects of DTR in the warm season and cold season for cause-specific cardiovascular diseases. RESULTS: Significant associations were found between DTR and ER admissions for all cardiovascular and cerebrovascular disease among elderly males, while DTR was significantly associated with ER admissions for all cardiovascular disease, ischemic heart disease and cerebrovascular disease among elderly females. People aged 75 years and older were more vulnerable to DTR. DTR caused greater adverse effects on both genders in the warm season, whereas the effect estimates on females were higher in cold season than in warm season. CONCLUSIONS: A short-term increase of DTR was significantly associated with ER admissions for cause-specific cardiovascular disease among the elderly in Beijing. Gender, age and season may modify the acute health effect of DTR. Some prevention programs that target the high risk subgroups in the elderly for impending large temperature changes may reduce the impact of DTR on people's health.

[Distribution characteristics of atmospheric pollutants and their effects on human health in Lanzhou City].

OBJECTIVE: To evaluate the distribution characteristics of atmospheric pollutants in Lanzhou City and their health-effects on daily respiratory disease hospital admissions. METHODS: Using the same period atmospheric pollutants (PM10, SO2 and NO2) data, meteorological data and daily respiratory disease hospital admissions data, from 2001 to 2009 in Lanzhou, to analysis of the distribution of three air pollutants(PM10, SO2 and NO2), and their correlation with meteorological factors. On this basis, a time series semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between air pollution and daily respiratory disease hospital admissions. RESULTS: The concentrations of PM10 and SO2 showed a decreased trends during the study period of 9 years, and NO2 showed weakly fluctuations and remained substantially unchanged. The highest concentrations of the three pollutants were presented in the winter and the lowest value were presented in the summer. PM10 concentration monthly distribution was bimodal distribution, SO2 and NO2 were unimodal distribution. There were significantly correlation between meteorological factors and pollutants. The results showed that there was certain lag effect of three kinds of air pollutants on daily respiratory disease hospital admissions. The lag time of three air pollutants all were 0 - 6 day moving average (avg06). An increase of 10 µg/m in PM10, SO2 and NO2 were significantly associated with the excess risk (ER) of 0. 45%, 1. 35% and 3. 02% for all respiratory hospital admissions. CONCLUSION: The ambient NO2, SO2 and PM10 concentrations have an adverse effect on daily hospital admissions for respiratory diseases of residents in Lanzhou City.

Clinical research on shengjie tongyu granules in the treatment of meteorological cardiovascular disease.

This paper aims to study the effect of Shengjie Tongyu granules on the treatment of meteorological cardiovascular disease in clinical treatment. Tongxinluo capsule that is clinically recognized as the effective drug in treating coronary heart disease and angina and was adopted as positive control. The results showed that, angina score and TCM score of two groups were all significantly improved after the treatment (P<0.01), but there was no statistical significance in comparison between groups (P>0.05); total effective rate of angina in the treatment group (77.78%) was superior than the control group (62.52%) after the treatment; but the difference had no statistical significance (P>0.05); total effective rate of TCM syndrome in the treatment group (75%) was superior than the control group (58.62%), and the difference had statistical significance (P<0.05). All these findings suggested that, Shengjie Tongyu granules can effectively improve the clinical symptoms of patients with coronary heart disease and angina, with the curative effect similar to Tongxinluo capsule; meanwhile, it can increase HDL-C and improve abnormal lipid metabolism of angina patient. In the treatment process, there is no significant untoward effect, blood, routine urine test and hepatorenal function have no abnormality, which proves that this drug is safe.

Effects of Long-Term Dust Exposure on Human Respiratory System Health in Minqin County, China.

The aim of this study was to assess the effects of long-term sand dust exposure on human respiratory health. Dust events break out frequently in Minqin County, northwest China, whereas Pingliang City, northwest China, is rarely influenced by dust events. Therefore, Minqin and Pingliang were selected as sand dust exposure region and control area, respectively. The incidence of respiratory system diseases and symptoms was determined through a structured respiratory health questionnaire (ATS-DLD-78-A) and personal interviews. The subjects comprised 728 farmers (Minqin, 424; Pingliang, 304) aged 40 years or older, who had nondocumented occupational history to industrial dust exposure. Prevalences (odds ratio [OR], 95% confidence interval [CI]) of chronic rhinitis, chronic bronchitis, and chronic cough increased 9.6% (3.141, 1.776-5.555), 7.5% (2.468, 1.421-4.286), and 10.2% (1.787, 1.246-2.563) in Minqin comparison with Pingliang, respectively, and the differences were significant (p <.01).

[Application of artificial neural networks in forecasting the number of circulatory system diseases death toll].

OBJECTIVE: Set up the model of forecasting the number of circulatorys death toll based on back-propagation (BP) artificial neural networks discuss the relationship between the circulatory system diseases death toll meteorological factors and ambient air pollution. METHODS: The data of tem deaths, meteorological factors, and ambient air pollution within the m 2004 to 2009 in Nanjing were collected. On the basis of analyzing the ficient between CSDDT meteorological factors and ambient air pollution, leutral network model of CSDDT was built for 2004 - 2008 based on factors and ambient air pollution within the same time, and the data of 2009 est the predictive power of the model. RESULTS: There was a closely system diseases relationship between meteorological factors, ambient air pollution and the circulatory system diseases death toll. The ANN model structure was 17 -16 -1, 17 input notes, 16 hidden notes and 1 output note. The training precision was 0. 005 and the final error was 0. 004 999 42 after 487 training steps. The results of forecast show that predict accuracy over 78. 62%. CONCLUSIONS: This method is easy to be finished with smaller error, and higher ability on circulatory system death toll on independent prediction, which can provide a new method for forecasting medical-meteorological forecast and have the value of further research.

The association between diurnal temperature range and emergency room admissions for cardiovascular, respiratory, digestive and genitourinary disease among the elderly: a time series study.

OBJECTIVES: To evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) admissions among elderly adults in Beijing. METHODS: After controlling the long-time and seasonal trend, weather, air pollution and other confounding factors, a semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between DTR and daily ER admissions among elderly adults with different lag structures from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by age and gender, and conducted the modifying effect of season on DTR to test the possible interaction. RESULTS: Significant associations were found between DTR and four major causes of daily ER admissions among elderly adults in Beijing. A 1 °C increase in the 8-day moving average of DTR (lag 07) corresponded to an increase of 2.08% (95% CI: 0.88%-3.29%) in respiratory ER admissions and 2.14% (95% CI: 0.71%-3.59%) in digestive ER admissions. A 1 °C increase in the 3-day and 6-day moving average of DTR (lag 02 and lag 05) corresponded to a 0.76% (95% CI: 0.07%-1.46%) increase in cardiovascular ER admissions, and 1.81% (95% CI: 0.21%-3.45%) increase in genitourinary ER admissions, respectively. The people aged 75 years and older were associated more strongly with DTR than the 65-74 age group. The modifying effect of season on DTR was observed and it was various in four causes. CONCLUSIONS: This study strengthens the evidence that DTR is an independent risk factor for ER admissions among elderly persons. Some prevention programs that target the elderly and other high risk subgroups for impending large temperature changes may reduce the impact of DTR on people's health.

Short-term effects of gaseous pollutants and particulate matter on daily hospital admissions for cardio-cerebrovascular disease in Lanzhou: evidence from a heavily polluted city in China.

Panel studies show a consistent association between increase in the cardiovascular hospitalizations with air pollutants in economically developed regions, but little evidence in less developed inland areas. In this study, a time-series analysis was used to examine the specific effects of major air pollutants [particulate matter less than 10 microns in diameter (PM(10)), sulfur dioxide (SO(2)), and nitrogen dioxides (NO(2))] on daily hospital admissions for cardio-cerebrovascular diseases in Lanzhou, a heavily polluted city in China. We examined the effects of air pollutants for stratified groups by age and gender, and conducted the modifying effect of seasons on air pollutants to test the possible interaction. The significant associations were found between PM(10), SO(2) and NO(2) and cardiac disease admissions, SO(2) and NO(2) were found to be associated with the cerebrovascular disease admissions. The elderly was associated more strongly with gaseous pollutants than younger. The modifying effect of seasons on air pollutants also existed. The significant effect of gaseous pollutants (SO(2) and NO(2)) was found on daily hospital admissions even after adjustment for other pollutants except for SO(2) on cardiac diseases. In a word, this study provides the evidence for the detrimental short-term health effects of urban gaseous pollutants on cardio-cerebrovascular diseases in Lanzhou.

[A time-series study on the relationship between gaseous air pollutants and daily hospitalization of respiratory disease in Lanzhou City].

OBJECTIVE: To evaluate the relationship between exposure to gaseous air pollutants (NO2 and SO2) and daily hospital admissions for respiratory diseases. METHODS: After controlling long time trend, the "day of week" effect and confounding factors of meteorology, a semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between gaseous air pollutants and daily respiratory hospital visits from 2001 to 2005 in Lanzhou city. RESULTS: Both NO2 and SO2 have positive relationships with residents' hospital visits for respiratory complaints. In single-pollutant models, the best fits for NO2 and SO2 were one day after (Lag1) and the same day visit (Lag0). With an IQR concentration increase in NO2 (Lag1) and SO2 (Lag0), the relative risks of daily hospital admissions for respiratory diseases were 1.060 (95% CI 1.046-1.074) and 1.048 (95% CI 1.031-1.065), respectively. The susceptible populations were female and the elderly. The health effect of gaseous air pollution was more obvious in autumn and winter. CONCLUSION: The ambient NO2 and SO2 concentrations have an adverse effect on daily hospital visits for respiratory diseases of residents in Lanzhou.

Simulation of the long-term transfer and fate of DDT in Lanzhou, China.

A level IV fugacity model is used to simulate the fate and transfer of DDT in the Lanzhou area over a 67-year period from their introduction into agricultural field until 2019. The established model is successfully applied to simulate the transfer processes and the concentration distribution of DDT in four environmental compartments: air, water, soil, and sediment in Lanzhou area under non-steady state assumptions. Furthermore, the calculated results agree well with monitoring data from the literature in same period of time. We assume 20% of the total usage of DDT enters into air and 80% enters the soils. The results indicate that the main source of DDT in the area is agricultural application, the biggest bulk sink is soil (accounting for 99.8% of total amount in the environment). Among all the transfer processes, the deposition from air to soil, deposition from air to water, soil erosion, and sedimentation from water to sediment are the primary processes, and the degradation in soil and air are the key process of DDT disappearance.